Ma. Grados et al., Depth of lesion model in children and adolescents with moderate to severe traumatic brain injury: use of SPGR MRI to predict severity and outcome, J NE NE PSY, 70(3), 2001, pp. 350-358
Objectives-The utility of a depth of lesion classification using an SPGR MR
I sequence in children with moderate to severe traumatic brain injury (TBI)
was examined. Clinical and depth of lesion classification measures of TBI
severity were used to predict neurological and functional outcome after TBI
.
Methods-One hundred and six children, aged 4 to 19, with moderate to severe
TBI admitted to a rehabilitation unit had an SPGR MRI sequence obtained 3
months after TBI. Acquired images were analyzed for location, number, and s
ize of lesions. The Glasgow coma scale (GCS) was the clinical indicator of
severity. The deepest lesion present was used for depth of lesion classific
ation. Speed of injury was inferred from the type of injury. The disability
rating scale at the time of discharge from the rehabilitation unit (DRS1)
and at 1 year follow up (DRS2) were functional outcome measures.
Results-The depth of lesion classification was significantly correlated wit
h GCS Severity, number of lesions, and both functional measures, DRS1 and D
RS2. This result was more robust for time 1, probably due to the greater nu
mber of psychosocial factors impacting on functioning at time 2. Lesion vol
ume was not correlated with the depth of lesion model. In multivariate mode
ls, depth of lesion was most predictive of DRS1, whereas GCS was most predi
ctive of DRS2.
Conclusions-A depth of lesion classification of TBI severity may have clini
cal utility in predicting functional outcome in children and adolescents wi
th moderate to severe TBI.